Modernizing Kentucky’s Step Therapy Law Will Ensure Better and More Timely Access to Rx Medications

Frankfort, Ky. —Thanks to the forward-thinking action of Kentucky lawmakers in 2012, the Commonwealth was one of the first states to enact step therapy reform to help ensure timely, barrier-free access to care for its residents. Now, a decade later in the wake of evolving clinical and insurance practices, state Senator Max Wise is sponsoring a bill to update the law. Senate Bill 140 modernizes the law to ensure Kentuckians can continue to access medications prescribed by their doctor without delay.
 
“We applaud Kentucky lawmakers for leading the charge in addressing step therapy laws and paving the way to improved patient access to health care,” said Dr. Madelaine Feldman, who is President of the Coalition of State Rheumatology Organizations. “Now, a decade later, it’s important to make some commonsense updates that will ensure this legislation continues to serve Kentuckians as the legislature intended in 2012.”  
 
Step therapy, also known as “fail first,” is a practice that requires patients to try one or more prescription medications chosen by their health insurer before they can access the treatment prescribed by their doctor. The patient only gains access to the originally prescribed medication when they “fail” on the medicine first required by their insurer.
 
“Step therapy practices can sometimes cause critical delays in care for patients with chronic, complex diseases and lead to worse health outcomes,” said Feldman. “That’s why we’re supporting these important updates to the law to ensure healthcare decisions remain between patients and their doctors.”  
 
This new legislation would make two very meaningful improvements to the current law including, ensuring step therapy protocols are based on widely accepted medical and clinical guidelines and updating the circumstances for a patient and health care provider to access the medication that is best for the patient.
 
At least 30 states have already updated their laws to create exceptions to step therapy protocols required by insurers and pharmacy benefit managers (PBMs). It’s time for Kentucky do the same.
 
More than two dozen organizations representing Kentucky patients and healthcare providers are working to update the step therapy law in 2022.